<!-- Modal -->
<div class="modal-dialog wide" style="width: 550px;">
<div class="modal-content">
    <div class="modal-header">
        <button type="button" class="close" data-dismiss="modal" aria-hidden="true">&times;</button>
        <h4 class="modal-title" id="myModalLabel">
            <#if xcQualified??>
                <#if xcQualified.id??>
                    编辑
                <#else>
                    新增
                </#if>
            </#if>
        </h4>
    </div>
    <div class="modal-body">
        <div id="errorMessage"><#include "../../message.ftl" /></div>
        <form class="form-horizontal" role="form" id="xcQualifiedForm" method="post" action="${absoluteContextPath}/xc/xcQualified/save">
            <#if xcQualified??>
                <#if xcQualified.id??>
                    <input type="hidden" name="id" value="${xcQualified.id}"/>
                <#else>
                    <input type="hidden" name="id" value=""/>
                </#if>
            </#if>
            <div class="row">
            <div class="form-group col-md-12">
                <label class="col-sm-4 control-label"></label>
                <div class="col-sm-6">
                    <input name="id" value="${xcQualified.id!''}" type="text" class="form-control"/>
                </div>
            </div>
            <div class="form-group col-md-12">
                <label class="col-sm-4 control-label">卡号</label>
                <div class="col-sm-6">
                    <input name="cardId" value="${xcQualified.cardId!''}" type="text" class="form-control"/>
                </div>
            </div>
            <div class="form-group col-md-12">
                <label class="col-sm-4 control-label">社保卡号</label>
                <div class="col-sm-6">
                    <input name="socialId" value="${xcQualified.socialId!''}" type="text" class="form-control"/>
                </div>
            </div>
            <div class="form-group col-md-12">
                <label class="col-sm-4 control-label">姓名</label>
                <div class="col-sm-6">
                    <input name="customerName" value="${xcQualified.customerName!''}" type="text" class="form-control"/>
                </div>
            </div>
            <div class="form-group col-md-12">
                <label class="col-sm-4 control-label">是否贵宾</label>
                <div class="col-sm-6">
                    <input name="vip" value="${xcQualified.vip!''}" type="text" class="form-control"/>
                </div>
            </div>
            <div class="form-group col-md-12">
                <label class="col-sm-4 control-label">预约号</label>
                <div class="col-sm-6">
                    <input name="bookId" value="${xcQualified.bookId!''}" type="text" class="form-control"/>
                </div>
            </div>
            <div class="form-group col-md-12">
                <label class="col-sm-4 control-label">预约类型</label>
                <div class="col-sm-6">
                    <input name="boolType" value="${xcQualified.boolType!''}" type="text" class="form-control"/>
                </div>
            </div>
            <div class="form-group col-md-12">
                <label class="col-sm-4 control-label">性别</label>
                <div class="col-sm-6">
                    <input name="sex" value="${xcQualified.sex!''}" type="text" class="form-control"/>
                </div>
            </div>
            <div class="form-group col-md-12">
                <label class="col-sm-4 control-label">年龄</label>
                <div class="col-sm-6">
                    <input name="age" value="${xcQualified.age!''}" type="text" class="form-control"/>
                </div>
            </div>
            <div class="form-group col-md-12">
                <label class="col-sm-4 control-label">手机</label>
                <div class="col-sm-6">
                    <input name="phone" value="${xcQualified.phone!''}" type="text" class="form-control"/>
                </div>
            </div>
            <div class="form-group col-md-12">
                <label class="col-sm-4 control-label">所属团体</label>
                <div class="col-sm-6">
                    <input name="groups" value="${xcQualified.groups!''}" type="text" class="form-control"/>
                </div>
            </div>
            <div class="form-group col-md-12">
                <label class="col-sm-4 control-label">预约所属团队</label>
                <div class="col-sm-6">
                    <input name="boolGroups" value="${xcQualified.boolGroups!''}" type="text" class="form-control"/>
                </div>
            </div>
            <div class="form-group col-md-12">
                <label class="col-sm-4 control-label">部门</label>
                <div class="col-sm-6">
                    <input name="department" value="${xcQualified.department!''}" type="text" class="form-control"/>
                </div>
            </div>
            <div class="form-group col-md-12">
                <label class="col-sm-4 control-label">收费标志</label>
                <div class="col-sm-6">
                    <input name="chargeLoge" value="${xcQualified.chargeLoge!''}" type="text" class="form-control"/>
                </div>
            </div>
            <div class="form-group col-md-12">
                <label class="col-sm-4 control-label">体检标志</label>
                <div class="col-sm-6">
                    <input name="medicalLoge" value="${xcQualified.medicalLoge!''}" type="text" class="form-control"/>
                </div>
            </div>
            <div class="form-group col-md-12">
                <label class="col-sm-4 control-label">门诊ID</label>
                <div class="col-sm-6">
                    <input name="serviceId" value="${xcQualified.serviceId!''}" type="text" class="form-control"/>
                </div>
            </div>
            <div class="form-group col-md-12">
                <label class="col-sm-4 control-label">总检状态</label>
                <div class="col-sm-6">
                    <input name="checkStatus" value="${xcQualified.checkStatus!''}" type="text" class="form-control"/>
                </div>
            </div>
            <div class="form-group col-md-12">
                <label class="col-sm-4 control-label">科室负责人</label>
                <div class="col-sm-6">
                    <input name="departmentHead" value="${xcQualified.departmentHead!''}" type="text" class="form-control"/>
                </div>
            </div>
            <div class="form-group col-md-12">
                <label class="col-sm-4 control-label">身份证</label>
                <div class="col-sm-6">
                    <input name="idCard" value="${xcQualified.idCard!''}" type="text" class="form-control"/>
                </div>
            </div>
            <div class="form-group col-md-12">
                <label class="col-sm-4 control-label">操作员</label>
                <div class="col-sm-6">
                    <input name="operator" value="${xcQualified.operator!''}" type="text" class="form-control"/>
                </div>
            </div>
            <div class="form-group col-md-12">
                <label class="col-sm-4 control-label">开单人</label>
                <div class="col-sm-6">
                    <input name="person" value="${xcQualified.person!''}" type="text" class="form-control"/>
                </div>
            </div>
            <div class="form-group col-md-12">
                <label class="col-sm-4 control-label">介绍人</label>
                <div class="col-sm-6">
                    <input name="introduceName" value="${xcQualified.introduceName!''}" type="text" class="form-control"/>
                </div>
            </div>
            <div class="form-group col-md-12">
                <label class="col-sm-4 control-label">健康管理</label>
                <div class="col-sm-6">
                    <input name="healthManage" value="${xcQualified.healthManage!''}" type="text" class="form-control"/>
                </div>
            </div>
            <div class="form-group col-md-12">
                <label class="col-sm-4 control-label">健康自助测评</label>
                <div class="col-sm-6">
                    <input name="healthEvaluation" value="${xcQualified.healthEvaluation!''}" type="text" class="form-control"/>
                </div>
            </div>
            <div class="form-group col-md-12">
                <label class="col-sm-4 control-label">金额</label>
                <div class="col-sm-6">
                    <input name="money" value="${xcQualified.money!''}" type="text" class="form-control"/>
                </div>
            </div>
            <div class="form-group col-md-12">
                <label class="col-sm-4 control-label">减半金额</label>
                <div class="col-sm-6">
                    <input name="halfMoney" value="${xcQualified.halfMoney!''}" type="text" class="form-control"/>
                </div>
            </div>
            <div class="form-group col-md-12">
                <label class="col-sm-4 control-label">备注</label>
                <div class="col-sm-6">
                    <input name="note" value="${xcQualified.note!''}" type="text" class="form-control"/>
                </div>
            </div>
            <div class="form-group col-md-12">
                <label class="col-sm-4 control-label">信息采集人</label>
                <div class="col-sm-6">
                    <input name="information" value="${xcQualified.information!''}" type="text" class="form-control"/>
                </div>
            </div>
            <div class="form-group col-md-12">
                <label class="col-sm-4 control-label">赠送基因</label>
                <div class="col-sm-6">
                    <input name="gene" value="${xcQualified.gene!''}" type="text" class="form-control"/>
                </div>
            </div>
            <div class="form-group col-md-12">
                <label class="col-sm-4 control-label">基因介绍人</label>
                <div class="col-sm-6">
                    <input name="geneIntroducer" value="${xcQualified.geneIntroducer!''}" type="text" class="form-control"/>
                </div>
            </div>
            <div class="form-group col-md-12">
                <label class="col-sm-4 control-label">合并开单人</label>
                <div class="col-sm-6">
                    <input name="openName" value="${xcQualified.openName!''}" type="text" class="form-control"/>
                </div>
            </div>
            <div class="form-group col-md-12">
                <label class="col-sm-4 control-label">合格否</label>
                <div class="col-sm-6">
                    <input name="qualified" value="${xcQualified.qualified!''}" type="text" class="form-control"/>
                </div>
            </div>
            <div class="form-group col-md-12">
                <label class="col-sm-4 control-label">体检日期</label>
                <div class="col-sm-6">
                    <input name="riqiStart" value="${xcQualified.riqiStart!''}" type="text" class="form-control"/>
                </div>
            </div>
            <div class="form-group col-md-12">
                <label class="col-sm-4 control-label"></label>
                <div class="col-sm-6">
                    <input name="riqiEnd" value="${xcQualified.riqiEnd!''}" type="text" class="form-control"/>
                </div>
            </div>
            </div>
        </form>
    </div>
    <div class="modal-footer">
        <button type="button" class="btn btn-default" data-dismiss="modal" aria-hidden="true">关闭</button>
        <button type="button" class="btn btn-primary" onclick="save();">保存</button>
    </div>
</div>
</div>
<script>
    function save() {
        $("#" + "xcQualifiedForm").ajaxSubmit({
            success:function(data) {
                data = JSON.parse(data);
                if (data.returnCode == 1) {
                    $('#myModal').modal("hide");
                    $.showMessage({parentId:"showMessage",message:"信息保存成功！",type:"success"});
                    refreshTable();
                } else {
                    $.showMessage({parentId:"errorMessage",message:"<strong>错误信息</strong>：" + data.returnMsg,type:"error"});
                }
            }
        });
    }
</script>